On the cutting edge: Dr. Justin Routhier scrubs up and takes part in surgical procedures
Halfway through his surgical training at Signature Healthcare Brockton Hospital, Dr. Justin Routhier had operated on a dozen people. But he doesn’t count the surgeries by the number of people. He counts them in body parts.
That was not Jerry Dunn of Whitman on the operating table. It was his gallbladder.
At least that was the way Dr. Justin Routhier saw his third surgery of the day.
Halfway through his month-long surgical training at Signature Healthcare Brockton Hospital, the resident had assisted as surgeons operated on a dozen people. But he doesn’t count the surgeries that way. He counts them in body parts.
“I did two appendix — what’s the plural of appendix? Appendices? Two of those this morning before breakfast,” Routhier said through his surgical mask, referring to the appendectomies in which he assisted staff surgeon Dr. Julie White.
He furiously scrubbed his hands and arms moments before he would help White again, this time to remove the gallbladder inside Dunn, 64. It was Routhier’s 50th surgery, he thinks, going back to his days as a medical student at Brown University — but he has stopped counting.
Surgery has no room for emotional attachment, he explained.
“What helps with, obviously, recognizing the patient as a person is meeting and greeting the patient before the operation, hearing their story, talking a little bit, joking around,” Routhier said.
He did just that with Jerry Dunn and his wife, Dianne, in the pre-operating room.
But being “semi-detached,” as he put it, is part of life in surgery.
“When you’re in the OR and the drapes are over the patient’s head, and you know the focal point is just the abdomen or whatever body part’s being operated on, it’s very easy to block the rest out,” Routhier said.
Routhier plans to complete his medical training at Brigham and Women’s Hospital, and wants to become a radiologist. But the yearlong residency at Signature requires doctors to get firsthand experience of other specialties — including surgery.
“It really opens their eyes to an entire class of patients and cases,” said Dr. David Drinkwater, chief of surgery at the hospital.
“They’re ultimately going to be the consultants for the surgeons, so they’ll be in their shoes,” added Dr. Dale Ellenberg, their medical education director at Signature.
Med students generally assist in the “basics” of surgery — incisions, suturing and caring for a surgical patient — in their third year of medical school, said Ellenberg, so they have experience in the OR. How much they do during their residency depends on the surgeon they are assisting.
This gallbladder removal was expected to take an hour — “nothing” for Routhier, compared to some surgeries he assisted in while a student.
“I’ve been on a couple cases, like gastric bypass surgeries, that have lasted a long time, and you can’t complain,” he said, shrugging as he recalled hunching over for 10 hours during one surgery.
But that wouldn’t be the case today. If gastric bypass were the three-course meal of surgical procedures, gallbladder removal, it seemed, would be the drive-through window.
A surgical solution
Dunn’s gallbladder had to be removed because a pebble-size ball of bile, or gallstone, had formed inside, then caused an infection when it left the organ and blocked the duct leading to the pancreas.
Dunn had passed the gallstone, but doctors feared the potentially dangerous situation could repeat itself.
The procedure would be done laparoscopically, using a technique that relies on inserting cameras and instruments into small incisions in the abdomen, instead of cutting open the body. Endoscopy — the general term used for any minimally invasive procedure done with cameras — is “much harder” than traditional surgery, Routhier later said.
“Things are lopsided, and you have to concentrate on the surgeon’s focal point the entire time,” he said. “You have to anticipate where they’re moving to next.”
A patient with frequent “gallbladder attacks” is recommend to have the organ removed to prevent future inflammations, according to the National Institutes of Health. It is a nonessential organ.
Inside the OR
It was 1:32 p.m., each passing second punctuated by another beep of the heart monitor.
There is no music in Dr. Julie White’s operating room. Yellow walls. Hushed voices. Few jokes. Plenty of pleases and thank-you’s.
An anesthesiologist stood at the patient’s head. Routhier and White flanked each side of Dunn.
A nurse stood near White, nestled between two cascading trays of surgical equipment — one extending over the patient’s feet.
The room was not large, but not cramped — despite the abundance of computers and machines that lined the perimeter, many of which remained untouched throughout the procedure.
Routhier and White connected the equipment to two televisions that would project the scene.
Once Dunn was anesthetized, Routhier pulled the skin taut with tweezers so White could make the first incision — about the diameter of a quarter — for a long rod-like instrument called a trocar, which had a camera attached.
“He’s got a scar here you want to try to avoid,” White quietly instructed Routhier before settling on an incision site.
A machine hummed in the back of the room. The patient’s belly inflated with carbon dioxide — “So we can see inside,” Routhier later explained.
Within minutes, four foot-long poles jutted from the man’s abdomen.
Routhier was mostly motionless — any movement could affect the surgeon or harm the patient — not so much as wiping sweat off his forehead or shifting his weight.
White went to work, snipping and sizzling fat off the gallbladder so it could be peeled off the liver, to which it is attached.
The surgeon and resident gazed over each other’s shoulders into twin TV screens — Routhier darting the camera around to trail White’s maneuvers.
White would sometimes announce her next move, but it was often up to Routhier to anticipate it.
After securing the gallbladder in a small, fishing net-like bag inside the belly — “Play basketball, doctor?” White asked Routhier — it was removed.
They released the air from Dunn’s belly, which rippled like a waterbed.
Nurses wheeled Dunn into the post-op room — a smiling Routhier was there to greet him when he came to.
It was just halfway through this rotation, but the 4:30 a.m. wake-up was wearing on him.
“I don’t have much time at home,” Routhier said later. “It kind of stinks, but it’s just one month and I just have to get through it.”
Today was just another gallbladder — out in an hour. No sweat.
The paperwork that follows — that would be the hard part.